Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Oct 17, 2022
Date Accepted: Feb 5, 2023
Disparity in lung cancer screening among smokers and non-smokers in China: Prospective cohort study
ABSTRACT
Background:
Low-dose computed tomography (LDCT) screening is effective in reducing lung cancer mortality in smokers, however the evidence in non-smokers is scarce.
Objective:
We aimed to evaluate the participant rate and effectiveness of one-off LDCT screening for lung cancer among smokers and non-smokers.
Methods:
A population-based prospective cohort study was performed to enroll participants aged 40 to 74 years from 2013 to 2019 from four cities of Zhejiang Province, China. Participants who were evaluated with high-risk of lung cancer from an established risk-score model were recommended to undertake LDCT screening. Follow-up outcomes were retrieved by 30 June 2020. The uptake rate of LDCT screening for evaluated high-risk participants and detection rate of early-stage lung cancer (stage 0–I) were calculated. The incident lung cancer, lung cancer mortality, and all-cause mortality were compared among high-risk screened group and non-screened group.
Results:
At baseline, 18,818 (62.6%) out of 30,379 smokers and 5,483 (6.0%) out of 91,455 non-smokers were identified as high-risk (P <.001), of whom 7,885 (41.9%) and 3,636 (66.3%) underwent LDCT screening (P <.001). After a median follow-up of 5.1 year, 1100 lung cancer cases, 456 all-cause death cases, and 116 lung cancer death cases were observed. The proportion of early-stage lung cancer was 60.4% (n = 173) among smokers and 80.3% (n = 476) among non-smokers, and a higher proportion was found in the screened group (67.9%) than the non-screened group (49.1%) among smokers (P =.005), while no significant results were found (95.5% vs. 83.3%; P=.198) among non-smokers. Compared with non-screened, LDCT screening in smokers significantly increased lung cancer incidence (HR=1.39, 95% CI 1.09–1.76), reduced lung cancer mortality (HR=0.52, 95% CI 0.28–0.96) and all-cause mortality (HR=0.47, 95% CI 0.32–0.69). Among non-smokers, no significant results were found for lung cancer incidence (P =.055), all-cause mortality (P =.89) and lung cancer mortality (P =.17).
Conclusions:
LDCT screening effectively reduces lung cancer and all-cause mortality among high-risk smokers. The participant rate and early detection of lung cancer was higher among non-smokers than smokers. Further efforts to defining high-risk population and exploring adequate lung cancer screening modality for non-smokers are needed.
Citation
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